Active NPI
Jacob Daniel Long, O.D.
- Optometrist
- Greenwood, MS
National Provider Identifier
1710329156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 887
- Practice address
- 2202 Hwy 82 West
Greenwood, MS 38930-2706 - Phone
- (662) 609-6402
- NPI assigned
- Jul 26, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 887 | MS | Primary |
Addresses
Primary practice location
2202 Hwy 82 West
Greenwood, MS 38930-2706
Mailing address
110 Acorn LN
Batesville, MS 38606-2359
Phone (662) 609-6402
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 887 | MS | MD | Chiropractor |
Interoperability endpoints
- jacob.long.1@20428.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374796800000",
"number": "1710329156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 ACORN LN",
"city": "BATESVILLE",
"state": "MS",
"postal_code": "386062359",
"telephone_number": "662-609-6402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2202 HWY 82 WEST",
"city": "GREENWOOD",
"state": "MS",
"postal_code": "389302706",
"telephone_number": "662-609-6402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "JACOB",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-26",
"last_updated": "2013-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MS",
"license": "887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.